2023-05-10T10:31:24-05:00 2022-06-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2021-07-01 010223482 Millinocket Regional Hospital MILL 2077235161 200 Somerset Street Millinocket ME 04462 Mellissa McAvoy Chief Financial Officer 2077235161 2023-05-02 1 Mellissa McAvoy 999009999 Connor Smart P02285543 2078792100 2023-05-02 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Robert Peterson DSc 200 Somerset Street Millinocket ME 04462 33152417 0 X www.mrhme.org X 1952 ME Critical Access Hospital 8 4 272 6 0 0 5677401 1330628 28263076 30887881 229184 221902 0 0 34169661 32440411 1500 2000 0 0 17645892 17768126 0 0 0 12733234 13935202 30380626 31705328 3789035 735083 17691355 18486700 8927895 9351964 8763460 9134736 X Millinocket Regional Hospital (MRH) is a critical access hospital that provides access to excellence in healthcare. 0 0 27911329 2000 30887881 Millinocket Regional Hospital (MRH) provides a broad scope of medical services to residents and guests in the Katahdin region. These services span the continuum of care and include inpatient, outpatient, emergency, and ancillary services. Inpatient care at MRH includes medical surgical care with availability of swing bed and special care services.The wide range of support services available at MRH features highly skilled staff and includes diagnostic imaging, cardiopulmonology, laboratory, rehabilitation, and wellness. MRH features a strong, cohesive medical staff consisting of family practice, internal medicine, general surgery, gastroenterology, orthopedics, ear nose & throat, urology, podiatry, cardiology, oncology, ophthalmology, podiatry, pulmonology, radiology, and urology.During this reporting period, MRH cared for:Inpatients - 1,927Clinic patients - 15,487Emergency room patients - 6,007In addition, MRH provided:Surgical services - 1,295Laboratory services - 94,033Radiology services - 11,841Therapy services (physical, speech, and occupational) - 8,240 27911329 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 36 0 1 272 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 4 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Mellissa McAvoy CFO 2077235161 200 Somerset Street Millinocket ME 04462 Jil Beaupain DPM Medical Staff At-Large 40.00 0.00 X 194900 0 0 Mellissa McAvoy Board President, CFO, COO 29.00 1.00 X X 99667 0 0 Kevin Olsen PA-C Medical Staff President 48.00 0.00 X 217574 0 6428 Andrea Sewall ANP Trustee 36.00 0.00 X 113126 0 13143 Herbert Clark Trustee (end 3/2022) 5.00 0.00 X 0 0 0 Gail Fanjoy Trustee 5.00 0.00 X 0 0 0 Patrick E Hunt Esq Trustee (end 3/2022) 5.00 0.00 X 0 0 0 Fred Lewis Trustee 5.00 0.00 X 0 0 0 Lee Chip Lamson Jr Board Vice President 5.00 0.00 X X 0 0 0 Thomas Malcolm Board Treasurer/Secretary 5.00 0.00 X X 0 0 0 Robert Peterson Chief Executive Officer 50.00 1.00 X 247470 0 12195 Kwaku Owusu-Abrokwa MD Physician 40.00 0.00 X 246899 0 11803 Edward Dunstan DO Physician 40.00 0.00 X 402294 0 18200 John Gluscic MD Physician 40.00 0.00 X 461399 0 12255 Mark Kowalski MD Physician 40.00 0.00 X 529018 0 20951 Sophia T Adams MD Physician 40.00 0.00 X 243038 0 11302 2755385 0 106277 24 0 1 1 Core Medical Group 655 S Willow Street Manchester NH 03103 Medical Staffing Services 234945 Dahl-Chase Diagnostic Services 417 State Street 439 Bangor ME 04401 Medical Laboratories 194919 Jil Beaupain DPM PO Box 130 Sherman ME 04776 Medical Services 194900 Alliance Healthcare Services 20 Hartford Street Houlton ME 04730 Medical Services 185607 Curative Talent 370 W Las Colinas Suite 104 Irving TX 75039 Medical Staffing Services 170290 7 5185 1149378 176065 1330628 Patient services 621110 29967759 29967759 340(b) Program 621990 410750 410750 Other medical services 621400 402569 402569 Nutrition and wellness 621300 106803 106803 30887881 77190 77190 839503 17215 712006 0 127497 17215 144712 144712 0 5185 0 0 32440411 30887881 0 221902 X 500 500 1500 1500 904503 253261 651242 13926851 12882094 1044757 246010 229359 16651 1716467 1482503 233964 974295 869460 104835 25031 25031 56295 56295 2399 2399 12856 12856 5462240 4177920 1284320 7626 7626 1078431 969804 108627 644517 579597 64920 29290 26340 2950 53168 47813 5355 137030 137030 613883 613883 411833 370351 41482 Med./pharm. supplies 3818826 3818826 Medicaid Assessment Tax 630419 630419 Provision for bad debt 443997 443997 Equipment expenses 308672 308672 198689 197404 1285 31705328 27911329 3793999 0 435654 450161 5879923 6074389 2640934 3158835 623723 742139 246197 357282 23005741 17679482 5252658 5326259 1976951 1690494 82623 130798 116692 76343 436000 480000 17691355 18486700 2526282 3072483 0 279973 310340 143507 3060999 3311335 3030274 2544666 8927895 9351964 X 8484240 8886059 279220 248677 8763460 9134736 17691355 18486700 735083 -354976 -8831 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 2399 0 0 0 2399 0 Part II-B, Line 1: Millinocket Regional Hospital pays annual dues to the Maine Hospital Association (MHA). A portion of these dues was deemed to be available for lobbying purposes. During fiscal year 2022, the Hospital paid dues of $17,384 to MHA, of which 13.8%, or approximately $2,399, was available for lobbying expenditures. 54551 54551 13212825 8262605 4950220 9647181 9416877 230304 91184 91184 5326259 Estimated Third Party Payor Settlements 2064666 Medical Malpractice Claims 480000 2544666 X 31628582 -354976 -354976 31983558 12856 443997 456853 32440411 31248475 0 31248475 12856 443997 456853 31705328 Part X, Line 2: Millinocket Regional Hospital (MRH) and Legacy Medical Foundation (LMF), a wholly-owned subsidiary of MRH, are organized as Maine nonprofit corporations and have been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items including unrelated business income or tax status. Under guidance issued by the Financial Accounting Standards Board, assets and liabilities are established for uncertain tax positions taken or positions expected to be taken in income tax returns when such positions are judged to not meet the "more-likely-than-not" threshold, based upon the technical merits of the position. The Hospital has evaluated the positions taken on its filed tax returns. The Hospital has concluded no uncertain income tax positions exist at June 30, 2022. The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 4b - Other Adjustments: Provision for bad debt 443,997. Part XII, Line 4b - Other Adjustments: Provision for bad debt 443,997. 1 1 1 X 1 X 1 1 0 0 160743 0 160743 0.00510 4190962 3671623 519339 0.01660 4351705 3671623 680082 0.02170 7066385 2887361 4179024 0.13370 7066385 2887361 4179024 0.13370 11418090 6558984 4859106 0.15540 1 235645 0 5979195 6960498 -981303 X 1 1 1 1 Millinocket Regional Hospital 200 Somerset Street Millinocket ME 04462 www.mrhme.org 38579 X X X Millinocket Regional Hospital 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X See Part V, Section C X See Part V, Section C X 1 21 1 See Part V, Section C 0 1 X 150.000000000000 200.000000000000 X X X X 1 1 X X X 1 X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X X 1 X 0 X X X X 1 X 0 0 Millinocket Regional Hospital Part V, Section B, Line 5: Millinocket Regional Hospital, as part of the Maine Shared Health Needs Assessment Planning Process Collaborative, recently completed its community health needs assessment process. This assessment is completed every two years. Using this data, MRH has developed a comprehensive strategic plan to address the major unmet health needs in the Katahdin Region.The Maine Shared Community Health Needs Assessment (CHNA) is a collaborative effort amongst Central Maine Healthcare (CMHC), MaineGeneral Health (MGH), MaineHealth (MH), Northern Light Health (NLH), the Maine Center for Disease Control and Prevention (Maine CDC), and Maine Department of Health and Human Services. Input was gathered through forums, community events, surveys, focus groups, and interviews that were carried out during 2021. Health priorities for the county, public health district, and the state were developed through community participation and voting at community forums. Additional details regarding how the Hospital assessed the health needs of its community are provided in the supplemental information to this Schedule H. Millinocket Regional Hospital Part V, Section B, Line 6a: The Maine Shared Community Health Needs Assessment (Maine Shared CHNA) is a collaboration between many different organizations, government agencies, and individuals. Hospital facilities that participated in the 2021 CHNA, in addition to Millinocket Regional Hospital, included: Central Maine Healthcare (CMHC); MaineGeneral Health (MGH); MaineHealth (MH); and Northern Light Health (NLH). Millinocket Regional Hospital Part V, Section B, Line 6b: The Maine Shared Community Health Needs Assessment (Maine Shared CHNA) is a collaboration between many different organizations, government agencies, and individuals. Non-hospital facilities that participated in the 2021 CHNA included: Bangor Public Health and Community Services; Center for Community Inclusion & Disability Studies, University of Maine; City of Bangor; Community Health Leadership Board; Downeast Public Health District; Eastern Maine Community College; Eastern Maine Development Corporation; Elliotsville Foundation, Inc.; Health Access Network; Maine Department of Health and Human Services; Midcoast Public Health District; Mobilize Katahdin, Millinocket Memorial Library; Northeastern Workforce Development Board; Office of Child and Family Services, Maine Department of Health and Human Services; Partners for Peace; Penobscot Community Health Care; Penquis Public Health District; Penquis Rape Response Services; Public Health Nursing; Maine Center for Disease Control and Prevention; Town of Dexter; and the United Way of Eastern Maine.Additionally, Funding for the Maine Shared CHNA is provided by the partnering healthcare systems with generous support from the Maine CDC and countless community partners and stakeholder groups. Additional funding was provided by the Maine Health Access Foundation and the Maine CDC to conduct additional outreach to engage those whose voices would not otherwise be distinctly heard. The Maine Shared CHNA is also supported in part by the U.S. Centers for Disease Control and Prevention (U.S. CDC) of the U.S. Department of Health and Human Services (U.S. DHHS) as part of the Preventive Health and Health Services Block Grant. The infrastructure for community-led efforts is gaining strength. We are grateful to those who put their trust in the Maine Shared Community Health Needs Assessment process. Together, the MSCHNA and each of our community hosts have strived to ensure their voices are reflected herein.Oral Survey Sponsors and Community Event Sponsors for the 2021-2022 CHNA included: Capital Area New Mainers Project; City of Portland's Minority Health Program; Gateway Community Services; Maine Access Immigrant Network; Maine Community Integration; Maine Department of Health and Human Services; Maine Immigrant and Refugee Services; Mano en Mano; New England Arab American Organization; New Mainers Public Health Initiative; Consumer Council System of Maine; Disability Rights Maine; Green A.M.E. Zion Church; Health Equity Alliance; Maine Continuum of Care; Maine Council on Aging; Maine Primary Care Association; and the Maine Youth Action Network.Lastly, months of planning were conducted by stakeholder groups including the Metrics Committee, Data Analysis Team, Community Engagement Committee, Health Equity Committee, and Local Planning teams. Significant analysis was conducted by epidemiologists at the Maine CDC and the University of Southern Maine's Muskie School of Public Service. Market Decisions Research provided quantitative and qualitative analysis and design and production support. John Snow, Inc. (JSI) provided methodology, community engagement, and qualitative analysis expertise and support. The oral survey was adapted from the City of Portland's Minority Health Program's survey. Special thanks to the Partnership for Children's Oral Health for their data contribution. Millinocket Regional Hospital Part V, Section B, Line 11: Understanding the current health status of the community is important in order to identify priorities for future planning and funding, the existing strengths and assets on which to build upon, and areas for further collaboration across organizations, institutions, and community groups.Millinocket Regional Hospital, as part of the Maine Shared Health Needs Assessment Planning Process Collaborative, recently completed its community health needs assessment process. This assessment is completed every two years. Using this data, MRH has developed a comprehensive strategic plan to address the major unmet health needs in the Katahdin Region.As part of a larger goal of measurably improving the health and wellbeing of its residents, Maine's four largest health-care systems: Central Maine HealthCare, Eastern Maine Healthcare Systems (EMHS), MaineGeneral Health, and MaineHealth - as well as the Maine Center for Disease Control and Prevention led a process to assess the health needs of residents across the entire state of Maine.The purpose of Millinocket Regional Hospital's two-year strategic plan is to identify key areas to focus on to improve and build on the high-quality services we provide. The strategic plan was developed based on MRH's mission, vision, and values in conjunction with our 2019 Community Needs Assessment data. Millinocket Regional Hospital is committed to providing health care services that employees and community are proud of!2021-2022 Strategic Plan Goals:- Quality and Safety: Provide high quality and safe care in accordance with national standards. - People: Recruit and retain a highly functional workforce that is engaged in MRH's Mission, Vision and Values - Service: Deliver services that meet and exceed patient and families' expectations - Community Health: Develop services and processes to enhance our Community Health needs - Technology Enhancements: Provide up to date technology for effective communication between the community and the staff. - Facility Master Plan: Renew the facility master plan based upon the community needs. QUALITY AND SAFETYStrategies to achieve this goal include:1. Identify and strive for best practices in clinical settings 2. Enhance the culture of safety 3. Align care given with patient expectations RECRUIT AND RETAIN A HIGH PERFORMING WORKFORCEStrategies to achieve this goal include:1. Hire and retain high functioning employees 2. Develop a highly engaged workforce 3. Create a culture of accountability 4. Create a culture of high performance DELIVERY OF EXCEPTIONAL PATIENT SERVICEStrategies to achieve this goal include:1. Convenient access to care 2. Consistent delivery of outstanding patient care with every encounter 3. Enhance transitions of care throughout the organization 4. Provide healthcare education to the community on a consistent basis DEVELOPMENT OF SERVICES TO ENHANCE OUR COMMUNITYStrategies to achieve this goal include:1. Alignment with partners in Penobscot County to implement Community Health Needs Assessment: Hunger/Food Security, Obesity, Chronic Disease Management, Mental Health Services, Substance Use Disorder, Covid-19 2. Provide leadership in the completion of the upcoming CHNA assessment 3. Develop a Community Benefits Report TECHNOLOGY ENHANCEMENTSStrategies to achieve this goal include:1. Technology enhancements to advance clinical care 2. Potential business opportunities 3. Maintain financial performance 4. Development or enhancement of new clinical programs and services FACILITY MASTER PLANNINGStrategies to achieve this goal include:1. Update Facility Master 2. Work with Board of Trustees and Leadership to develop facility plan Millinocket Regional Hospital Part V, Section B, Line 16j: Signage is posted at all registration sites informing patients of the availability of financial assistance. Applications are available at the registration desk. Part V, Section B, Line 7a and 7b: The CHNA is available on Millinocket Regional Hospital's website at: https://www.mrhme.org/strategicplan/The CHNA is also available on the Maine.gov webpage at:https://www.maine.gov/dhhs/mecdc/phdata/MaineCHNA/documents/county-reports/2022/Penobscot%20County%20MSCHNA%20Report%202022.pdfThe Hospital's Strategic Plan for 2021-2022 is available on Millinocket Regional Hospital's website at:https://www.mrhme.org/wp-content/uploads/2021/08/2021-Strategic-Plan.pdf Part V, Section B, Line 16a, 16b, and 16c: The Hospital's Financial Assistance Policy documents can be found on the MRH website at: https://www.mrhme.org/patient-resources/financial-assistance/The Hospital's entire Financial Assistance Policy can be found on the MRH website at:https://www.mrhme.org/wp-content/uploads/2014/06/Financial-Assistance-Policy-050116.pdfThe Hospital's Application for Patient Free Care/Discount Arrangements can be found on the MRH website at:https://www.mrhme.org/wp-content/uploads/2023/01/Free-Care-2023-merged.pdfThe Hospital's Plain Language Summary can be found can be found on the MRH website at: https://www.mrhme.org/wp-content/uploads/2019/02/Financial-Assistance-Policy-Plain-Language-010118.pdf 2 1 - White Birch Medical Center 899 Central Street Millinocket ME 04462 Physical Therapy and Wellness Center 2 - Millinocket Regional Hosp Walk-In Care 87 Main Street East Millinocket ME 04430 Walk-In Care Part I, Line 3c: In addition to FPG, Millinocket Regional Hospital considers a patient's asset level, medical indigency, and insurance status. Presumptive eligibility may be used if all other financial assistance options have been exhausted. Part I, Line 7: Charity care expenses are converted to a cost-basis on this Schedule H, Part I, Line 7a. The conversion is based on an overall cost-to-charge ratio that addresses all patient segments. Additionally, the amounts reported on this Schedule H, Part I, Lines 7b and 7g were determined using the Medicaid and Medicare cost reports, respectively.In determining the amounts reported on this Schedule H, Part I, Line 7, bad debt expenses of $443,997 were removed from the calculations in accordance with IRS Instructions for Schedule H. These same bad debt expenses are reflected on this Form 990, Part IX. Part I, Line 7g: Millinocket Regional Hospital has several hospital clinical services and hospital-owned physician practices. In accordance with IRS Instructions for the Form 990, Schedule H, Worksheet 6, organizations may include any applicable physician practices that are subsidized during the completion of Schedule H. Furthermore, the definitions for Schedule H, Worksheet 6 indicate that operating a service at a loss may constitute subsidizing a health service. Therefore, the Hospital has included the following hospital clinical services and hospital-owned physician practices that operated at a loss, and their associated costs, in the calculations for the Hospital's total subsidized health services, as reported on this Schedule H.a - Hospital based rural health clinicb - Outpatient clinicc - Millinocket Surgicald - Orthopedicse - Urologyf - Wound Careg - Ophthalmologyh - Walk in ClinicThe above-listed hospital clinical services and hospital-owned physician practices have a community benefit (i.e. aggregate loss or subsidy from the Hospital) of approximately $4.179 million. In addition, this community benefit-figure does not take into account bad debts, charity care, or contractual adjustments. Thus, this community benefit of approximately $4.179 million is a conservative figure that reconciles to the community benefit information reported on IRS Form 990, Schedule H, Part I, Line 7g, Column e.Form 990, Schedule H instructions and guidance contains a template (Worksheet 2) that may be used to determine the overall cost to charge ratio that could be applied throughout Schedule H in order to convert charges to a cost-of-service basis. Where applicable, the Hospital has utilized Worksheet 2 for various calculations. The only areas where Worksheet 2 was not utilized was in the preparation of this Schedule H, Part 1, Line 7, were the following:a. Schedule H Worksheet 6, Subsidized Health Services (the supporting worksheet for Part I, Line 7g): the Hospital did not utilize Worksheet 2 when calculating the percentage used when determining the profit or loss of each hospital clinical service and hospital-owned physician practice. Instead, when compiling the subsidized hospital clinical services and hospital-owned physician practices listed in 1c, the Hospital utilized the actual estimated costs on the modified Medicare cost report instead of applying the Worksheet 2 cost to charge percentage. b. Schedule H, Worksheet 3, Unreimbursed Medicaid and Other Means Tested Government Programs (the supporting schedule for Part I, Lines 7b and 7c); and Worksheet 6, Medicaid Allowable Costs for Subsidized Health Services, listed in line 1c above (which is part of the line 7g costs): the Hospital did not utilize the Worksheet 2 cost to charge percentage when calculating the Medicaid allowable cost. Instead, the Hospital utilized the actual, filed Medicaid cost report for the allowable costs. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 443,997. Part II, Community Building Activities: Millinocket Regional Hospital (MRH) has a long history of serving citizens in the Katahdin region and those citizens have long supported MRH. Through many difficult times that partnership has sustained both the region and local healthcare services. As the Katahdin region reinvents itself and moves forward MRH is moving forward as well and is excited to announce the establishment of a new foundation - the Legacy Medical Foundation - designed to develop a comprehensive philanthropy and stewardship effort. All foundation initiatives will be focused on expanding access to care and wellness services provided in the Kathadin region.The Hospital also regularly engages with area schools to promote youth health, education, and wellness initiatives. During the past few years, these activities took on special significance, as the Hospital sought to promote COVID-19 vaccination and to quell vaccine hesitancy in its community. MRH devoted much of its time and resources to combatting COVID-19 in its community, from vaccine clinics to public information campaigns. The Hospital also took efforts to teach children and families how they can stay safe and healthy at home, in school, and in the workplace.As a major healthcare provider in Northern Maine near the Katahdin Woods and Waters region, the Hospital actively encourages healthy lifestyles and provides many economic and health care opportunities to its broader community. The Hospital also educates its community on how to avoid healthcare-related scams and financial fraud. Part III, Line 2: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. Balances that are still outstanding, after management has used reasonable collection efforts, are written off through a charge to the valuation allowance and a credit to patient accounts receivable.In evaluating the collectability of accounts receivable, the Hospital analyzes past results and identifies trends for major payor sources of revenue for the purposes of estimating the appropriate amount for the allowance for doubtful accounts and the provision for bad debts. Data in each major payor source are regularly reviewed to evaluate the adequacy of the allowance for doubtful accounts. Specifically, for receivables relating to services provided to patients having third-party coverage, an allowance for doubtful accounts and a corresponding provision for bad debts are established at varying levels based on the age of the receivables and payor source. For receivables relating to self-pay patients, a provision for bad debts is made in the period services are rendered based on experience, indicating the inability or unwillingness of patients to pay amounts for which they are financially responsible. Part III, Line 4: See Footnote 3 of the audited financial statements. Part III, Line 8: Medicare allowable cost of care was calculated from the Medicare cost report for the fiscal year ending June 30, 2022. Medical services are provided to patients with Medicare coverage regardless of whether or not a surplus or deficit is realized. Providing Medicare services promotes access to healthcare services which are vitally needed by our community. The Medicare cost report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services.As a critical access hospital, Millinocket Regional Hospital is reimbursed at 101% of Medicare allowable cost. Part III, Line 9b: In an effort to best serve our patients, all first-time statements include information on the availability of financial assistance for qualified patients. Our patient financial services department uses several resources to determine if a patient may be presumptively eligible for finance assistance; for example, eligibility for out-of-state Medicaid, or eligibility for other state-funded assistance programs, such as food stamps and patient homelessness. It is our practice to make a reasonable attempt to determine if a patient qualifies for financial assistance before sending an account to a collection agency. Any accounts previously sent to collections will be considered for financial assistance when an application is received, so long as the services were rendered not more than 240 days previously, or the patient was given a written notice that financial assistance was available for those specific services with a deadline dated after the 240 day period. Part VI, Line 2: The Maine Shared CHNA is a public-private collaboration governed by a Steering Committee, which is made up of representatives of each member organization (CMHC, MGH, MH, NLH, and Maine CDC). The Steering Committee sets fiscal and operational goals that are then implemented by the Maine Shared CHNA Program Manager. Input is provided by key stakeholder groups including the Metrics Committee and the Health Equity/Community Engagement Committee.The Metrics Committee is charged with creating and reviewing a common set of population/community health indicators and measures every three years. Before the 2018-2019 Maine Shared CHNA, the Metrics Committee conducted an extensive review of the data using the following criteria as a guide: 1.] describes an emerging health issue; 2.] describes one or more social determinants of health; 3.] measures an actionable issue; 4.] the issue is known to have high health and social costs; 5.] rounds out our description of population health; 6.] aligns with national health assessments (e.g.: County Health Rankings, American Health Rankings, Healthy People); 7.] data is less than 2 years old; 8.] data was included in the previous data set, or 9.] the Maine CDC analyzes the indicator in a current program. This review process was carried into the 2021-2022 Maine Shared CHNA, where the Metrics Committee also reviewed the previous data set to check for changes in data sources, potential new sources of data to round out certain topics, and to deepen Social Determinants of Health data which many of our partners have included in their work.The Health Equity/Community Engagement Committee is charged with updating outreach methodology to ensure a collection of broad, diverse, and representative qualitative data from groups that are more likely to experience health disparities. To ensure these methods reflect the needs and cultural expectations this committee included representatives from a variety of Maine's ethnic-based and community-based organizations, along with representatives from public health and healthcare, and a variety of additional partners.The 2021-2022 Maine Shared CHNA process involved three phases:1 - Data Analysis:The first phase of the project involved the analysis of more than 220 health indicators for the state, counties, public health districts, selected cities, and by specific demographics when available. Data analysis was conducted by the Maine CDC and its epidemiology contractor, the University of Southern Maine with additional support from the contracted vendor, Market Decisions Research.2 - Community Outreach and EngagementCommunity outreach and engagement for the Maine Shared CHNA included the following efforts:- 17 County Forums (Maine)- 9 Community Sponsored Events- 1,000 Oral SurveysCounty Forums were held in each of Maine's 16 counties, with one county, Penobscot, hosting one event in western Penobscot and one in eastern Penobscot in recognition of the differences between Greater Portland (Maine's most densely populated area) and the Lakes Region, (a more rural area). Local planning teams led by local healthcare and public health district liaisons organized and promoted these events. Participants were shown a PowerPoint presentation with relevant county data and were led through guided discussions to identify indicators of concern. Participants then voted to identify their top four health priorities. They were then asked to share their knowledge on gaps and assets available in their communities to address each of the top priorities identified.New this cycle was an expanded effort to reach those who experience systemic disadvantages and therefore experience a greater rate of health disparities. Two types of outreach were piloted. One effort included nine community-sponsored events. The hosts were chosen for their statewide reach. The communities included: Black or African American; Homeless or formerly homeless; LGBTQ+ community; Older adults; people who are deaf or hard of hearing; people who live with a disability; people with low income; people with a mental health diagnosis; youth.These events followed the same methodology as county forums with hosts providing input on the data presentation and leading the effort to recruit participants Oral surveys were conducted in collaboration with eight ethnic-based community organizations' (ECBO's) community health workers to better reach Maine's immigrant population. There were 1,000 surveys were conducted in either English (32%), Somali, (24%), Arabic (23%), French (8%), Spanish (5%), Lingala (3%), and other languages including Swahili, Maay Maay, Portuguese, Oromo, Eretria, Kirundi, and Amara. When asked for their countries of origin, respondents most commonly cited the United States (212), Iraq (205), Somalia (157), The Democratic Republic of Congo (81), Djibouti (70), Kenya (30), and Mexico (29). Other countries of origin mentioned included Rwanda, Ethiopia, Angola, Syria, Guatemala, South Africa, Palestine, Puerto Rico, Morocco, Afghanistan, El Salvador, Nigeria, Canada, Burundi, Eritrea, France, Honduras, Uganda, Jamaica, Mali, Gabon, Sudan, Nicaragua, Peru, and Brazil.The survey was an adaptation of the City of Portland's Minority Health Program Survey conducted in 2009, 2011, 2014, and 2018. In 2021, a small group of stakeholders convened to adapt this survey to meet the needs of the Maine Shared CHNA. This group included those who deployed the survey as well as other interested parties. Groups that piloted these new outreach methods were offered stipends for their time. Due to concerns related to COVID-19, community engagements efforts were conducted virtually except the event for the deaf or hard of hearing, which was held in a gymnasium at the Governor Baxter School for the Deaf on Mackworth Island. Oral surveys were conducted telephonically or by following current U.S. CDC COVID-19 protocols. Community engagement was supported by John Snow, Inc. (JSI), who also conducted the initial qualitative analysis. All support materials including Data Profiles and PowerPoints were produced by Market Decisions Research.3 - ReportingInitial analysis for each event and the oral surveys were reviewed by local hosts for accuracy and to ensure the information the community may find sensitive was flagged. Final CHNA reports for the state, each county, and districts were developed in the spring of 2022. Final Reports were written and produced by Market Decisions Research.In addition to Urban, County, and Health District reports, the County, District, and State level data are also available on an Interactive Data Portal. The data in the portal is arranged by health topic and provides demographic comparisons, trends over time, definitions, and information on the data sources. Visit www.mainechna.org and click on Interactive Data in the menu to the left. The Maine Shared CHNA website is hosted by the Maine DHHS. (www.mainechna.org).While our quantitative data pre-dates the COVID-19 pandemic, the 2021 community health needs assessment outreach took place during the pandemic, and participants noted its impacts in deep and meaningful ways. It was impossible not to recognize the pandemic's impacts on healthcare, health outcomes, behavioral health, and social support systems, especially for those who experience systemic disadvantages. Thus, the findings in the 2022 Maine Shared CHNA Reports which show the most often identified priorities such as mental health, substance and alcohol use, access to care, and social determinants of health take on new meaning and an increased sense of urgency.This is the fourth Maine Shared CHNA and the third conducted on a triennial basis. The Collaboration began with the One Maine initiative published in 2010. The project was renamed to the Shared Health Needs Assessment and Planning Process in 2015 which informed the 2016 final reports, and renamed to the Maine Shared CHNA in 2018, which informed the 2019 final reports. The 2021 community engagement cycle has informed the 2022 final reports. Part VI, Line 3: Inpatients: In order to identify those patients who would be eligible for financial assistance, all uninsured inpatients are referred to the financial counselor by pre-registration or registration personnel. The financial counselor will do an initial screening for payment options prior to the patient leaving the hospital, if possible. If the patient has left the hospital, the financial counselor will attempt to contact the patient for information. All inpatients are given a copy of patient free care and discount arrangements guidelines at time of admission.Surgical Outpatients: The financial counselor will provide information about patient free care, discount arrangements and term payment arrangements to all uninsured surgical outpatients. All surgical outpatients are provided a copy of patient free care and discount arrangements guidelines at time of registration.Emergency Room Patients: All emergency room patients are provided a copy of patient free care and discount arrangements guidelines at time of registration.All Other Outpatients: All other outpatients are provided a copy of the patient free care/discount arrangements guidelines at time of registration.All patients will receive notice of availability of financial assistance included in their first-time statement. Patient financial services employees and physician practice employees receive training on patient free care and discount arrangements guidelines and are expected to be able to provide contact information about free care and discount arrangements.The Hospital also provides the following information regarding financial assistance on their website:What Financial Assistance Is:Millinocket Regional Hospital (MRH) provides eligible patients partially or fully-discounted emergent or medically necessary hospital care. This is called "Free Care" when the care is fully discounted. Financial Assistance is based on the Federal Government's Federal Poverty Guidelines. If you believe you may be eligible for Financial Assistance, you must fill out a Financial Assistance application.How you can apply for Financial Assistance:You can find Financial Assistance applications and income guidelines at any place you register for services at MRH. You can also call our Patient Financial Services Offices at (207) 723-3369 or (207) 723-7247 and ask them to mail you an application, or download the forms here on our site.When filling out your application it is important that you complete all information to the best of your ability. You will be asked basic information about yourself and your family members, and you will be asked to provide documentation to verify family income. This information is confidential and is only used for the purpose of determining your discount. If you report no family income, we will also need to know how you meet your daily needs.You can return your application by mail to MRH at 200 Somerset Street, Millinocket, Maine, 04462, or by bringing it to the Hospital's registration desk or to the Financial Counselor's office, located in the office building next to MRH Family Medicine.Generally, patients are eligible for full or partial Financial Assistance when their Family Income is at or below 200% of the Federal Government's Federal Poverty Guidelines. Eligibility for Financial Assistance means that Eligible Persons will have their care covered fully or partially and they will not be charged more for emergency or other medically necessary care than amounts generally billed to insured persons.This policy only applies to services billed by Millinocket Regional Hospital and its Provider-Based Physicians. You may be separately billed by other service providers, such as physicians or laboratories, to which this policy does not apply. You should contact those providers directly about your bill.Only medically necessary care is eligible under the Financial Assistance Policy.Availability of Health Care Prices:Prices for our health care services are available upon request via registration points in the hospital and the hospital-based practices.Additional web-links for the Hospital's financial assistance documents and policies are found in the supplemental disclosures with this Schedule H. Part VI, Line 4: Millinocket Regional Hospital (MRH) has three communities in its primary service area: Millinocket, East Millinocket and Medway. There are multiple smaller communities in the secondary service area including Brownville, Woodville, Stacyville, Sherman, Patten and Island Falls. The area has struggled and realized an unemployment rate in the teens for the past ten years and experienced community out-migration. The population of the primary service area is approximately 7,500 people. The effect on the Hospital of this demographic and population change has been large declines in patient care volumes since 2013. The average median household income is more than 20% lower than the state average. The average resident age is more than 10% older than the state median age.MRH primarily services the Katahdin Region of Millinocket, East Millinocket and Medway. Our providers attend outreach clinics in Patten and Lincoln attending to patients in our secondary service areas. MRH offers acute inpatient and outpatient hospital services including 24/7 emergency care, rehabilitative services including a swing bed program as well as outpatient physician services.MRH has multiple locations including the main hospital campus at 200 Somerset Street, the White Birch Medical Center at 899 Central Street in Millinocket and the Ben Fiske Health Center located in Medway. Multiple office sites are also located adjacent to the main campus.Millinocket Regional Hospital participated in the 2021-2022 Maine Shared Community Health Needs Assessment for Penobscot County. This CHNA defined the Penobscot County demographics as follows:Penobscot has the third-largest population of State of Maine's counties; the 2021-2022 Maine Share CHNA estimated the population of Penobscot County to be approximately 151,200 individuals. Penobscot County has a lower income and educational attainment with higher rates of those living in poverty or with a disability compare to the state average. The County, per the CHNA, has an unemployment rate of 5.4%, which mirrored the state average. However, individuals living in poverty in Penobscot County was measured to be 14.8%, which is higher than the state average of 11.8%; though children living in poverty in Penobscot County (13.9%) was more comparable to the state average (13.8%). The county also has a younger population than the state average overall. The county is majority White race/ethnicity, at 94.5%, which is similar to the state's overall race/ethnic majority. Part VI, Line 5: Millinocket Regional Hospital is the largest employer in the area and sole community provider for acute care. We operate an emergency room available to all patients, regardless of their ability to pay. MRH is involved in government-sponsored health programs as well as the education and training of healthcare professionals, and we offer volunteer opportunities to Members within the community, who may not have a healthcare background, but are passionate about our mission. Our Hospital is governed by a Board of Trustees, all of whom reside in primary and secondary service areas. Employees may participate in board meetings but do not have voting capabilities, with the exception of the medical staff president, who has a voting membership on the governing Board. Board members whose family members are employed by MRH are required to identify the potential conflict in writing and are appropriately recused from acting on matters that may impact directly or indirectly their family members. Physicians who wish to have privileges at our Hospital are not required to be an employee in order to become an active member of the medical staff. They must send a written request to the MRH medical staff for review. Privileges are granted to qualified physicians only after the request is reviewed and the needs and interests of both parties have been evaluated. MRH is an active participant in the community care partnership of Maine, an accountable care organization made up of Maine based hospitals and healthcare centers, which guides our organization toward transforming the delivery of our healthcare services to center around meaningful sharing and accountability for our patients' health. As an organization, Millinocket Regional Hospital prioritizes surplus funds for projects or expenses that have a direct impact on patient care or patient and employee safety. This includes, but is not limited to, training, teaching, and purchasing specialized and improved equipment to keep patients safe. Part VI, Line 7, Reports Filed With States ME X X X X 0 0 0 0 0 0 0 0 0 Mark Kowalski MD Physician 528294 0 0 0 724 0 8700 0 12251 0 549969 0 0 0 John Gluscic MD Physician 441758 0 0 0 19641 0 8700 0 3555 0 473654 0 0 0 Edward Dunstan DO Physician 394794 0 0 0 7500 0 8700 0 9500 0 420494 0 0 0 Robert Peterson Chief Executive Officer 247050 0 0 0 420 0 7500 0 4695 0 259665 0 0 0 Kwaku Owusu-Abrokwa MD Physician 241418 0 0 0 5481 0 7473 0 4330 0 258702 0 0 0 Sophia T Adams MD Physician 223599 0 0 0 19439 0 2963 0 8339 0 254340 0 0 0 Kevin Olsen PA-C Medical Staff President 214254 0 0 0 3320 0 6428 0 0 0 224002 0 0 0 Jil Beaupain DPM Medical Staff At-Large 194900 0 0 0 0 0 0 0 0 0 194900 0 0 0 Form 990, Schedule J, Compensation Paid from Unrelated Organization: Millinocket Regional Hospital contracted with Calculations, Inc., an unrelated organization, to provide CFO services during the fiscal year. Calculations, Inc. was paid $99,667 for services provided by Mellissa McAvoy, who is an officer of Calculations, Inc. and served as Board President of MRH during the filing period. A Maine Health and Higher Educational Facilities Authority 010314384 560427WV4 2013-05-23 1423837 Refinancing of 2002 D Bond Issue 0 0 1 A 890762 1423837 15439 1408398 2013 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 Date Rebate Computation Performed Issuer Name: Maine Health and Higher Educational Facilities Authority Date the Rebate Computation was Performed: 06/25/2018 Daniel Herbert Family Member is employee of Hospital 15157 Daniel Herbert, MD, serves as Chief Medical Officer and a Trustee of Millinocket Regional Hospital. A family member, Laurie Vickers-Herbert, is an employee of the Hospital. 2021 W-2 compensation paid to Laurie Vickers-Herbert was $15,157. 0 Edward Dunstan DO Family Member is employee of Hospital 13199 Edward Dunstan, DO, serves as a top-employee of Millinocket Regional Hospital. A family member, Marie M. Dunstan, is also an employee of the Hospital. 2021 W-2 compensation paid to Marie M. Dunstan was $13,199. 0 Form 990, Part VI, Section A, line 3 Millinocket Regional Hospital contracted with Calculations, Inc., an unrelated organization, to provide CFO services during the fiscal year. Calculations, Inc. was paid $99,667 for services provided by Mellissa McAvoy, who is an officer of Calculations, Inc. and served as Board President of MRH during the filing period. Form 990, Part VI, Section B, line 11b Prior to the document's filing, the organization's finance department reviews the initial draft, which is prepared by an outside independent accountant. After any necessary changes are made, the organization's board members are presented with a copy. The finalized document is subject to the board's approval. Form 990, Part VI, Section B, line 12c Each board member is required to sign a conflict of interest disclosure form on an annual basis. In connection with any actual or possible conflicts of interest, an interested individual must disclose the existence of his or her conflict annually and whenever the conflict arises for action at a meeting. After receiving all annual attestations, the CEO will provide the signed statements to the hospital's attorney for review. After review, the attorney will determine if a conflict exists and inform the CEO and Board Chair of the conflicted individuals. There is a listing of board, medical staff and manager conflicts available at all meetings for reference. The agenda for every board, medical staff or department meeting will clearly list the discussion items that require action during the meeting. At the beginning of the meeting, the president will ask the members to review the list of action items and declare whether or not they have a conflict. All conflicted members will be required to excuse themselves and leave the room during the discussion and vote. If the board or committee has reasonable cause to believe that a member has failed to disclose actual or possible conflicts of interest, it shall inform the member of the basis for such belief and afford the member an opportunity to explain the alleged failure to disclose. Form 990, Part VI, Section B, line 15 The organization works with an independent compensation consultant to determine appropriate compensation levels. The organization's executive committee reviews data used to determine compensation for its respective members. Any compensation related changes must be approved by the Board of Trustees or the executive board. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part IX, line 11g Professional Services: Program service expenses 1,697,385. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,697,385. Outside Services: Program service expenses 75,677. Management and general expenses 0. Fundraising expenses 0. Total expenses 75,677. Contract Labor: Program service expenses 818,415. Management and general expenses 74,735. Fundraising expenses 0. Total expenses 893,150. Purchased Services: Program service expenses 1,586,443. Management and general expenses 1,209,585. Fundraising expenses 0. Total expenses 2,796,028. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. Legacy Medical Foundation 200 Somerset Street Millinocket ME 04462 852352634 Fundraising ME 501(c)(3) Line 12a, I Millinocket Regional Hospital 1 0 0 0 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 Legacy Medical Foundation D 18283 Actual per book Legacy Medical Foundation E 1137 Actual per book